Articulation joint for apparatus for endoscopic procedures

ABSTRACT

An endoscopic surgical device is provided and includes an endoscopic anchor retaining/advancing assembly including a proximal tube portion and a distal tube portion pivotably connected to one another at an articulation joint; a proximal inner shaft rotatably disposed within the proximal tube portion; a distal inner shaft rotatably disposed within the distal tube portion; and a relatively flexible intermediate drive cable mechanically interconnecting the proximal inner shaft and the distal inner shaft, wherein the intermediate drive cable extends across the articulation joint, wherein the intermediate drive cable defines a central longitudinal axis that is off-set a radial distance from a central longitudinal axis of the proximal tube portion and the distal tube portion.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of and priority to U.S. Provisional Patent Application No. 61/783,559, filed Mar. 14, 2013, the entire disclosure of which is incorporated by reference herein.

BACKGROUND

1. Technical Field

The present disclosure relates to surgical apparatus, devices and/or systems for performing endoscopic surgical procedures and methods of use thereof. More specifically, the present disclosure relates to an articulation joint for surgical apparatus, devices and/or systems for performing endoscopic surgical procedures.

2. Background of Related Art

During laparoscopic or endoscopic surgical procedures, access to a surgical site is achieved through a small incision or through a narrow cannula inserted through a small entrance wound in a patient. Because of limited area to access the surgical site, many endoscopic surgical devices include mechanisms for articulating the tool assembly of the device. Typically, the articulating mechanism is controlled by an actuator which has to be manipulated by a surgeon to properly orient the tool assembly in relation to tissue to be treated.

Some endoscopic surgical devices utilize torque-transmitting flexible drive cables and the like to transmit rotation around an articulation joint of the endoscopic surgical device. In order to accommodate the articulation desired, relatively more flexible torque-transmitting cables are used. However, the more flexible a cable is, the more “wind-up” of the cable that takes place and the more loss of the torque transmission that occurs.

Accordingly, a need exists for endoscopic surgical devices which utilize torque-transmitting flexible drive cables capable of transmitting relatively more torque, with a decrease in the degree of loss of torque transmission while maintaining a degree of articulation of the endoscopic surgical device.

SUMMARY

The present disclosure relates to electromechanical, hand-held surgical apparatus, devices and/or systems configured for use with removable disposable loading units and/or single use loading units for clamping, cutting and/or stapling tissue.

According to an aspect of the present disclosure, an endoscopic surgical device is provided and includes a handle assembly including a handle housing and a trigger operatively connected to the handle housing, and a drive mechanism actuatable by the trigger; and an endoscopic anchor retaining/advancing assembly extending from the handle assembly. The endoscopic anchor retaining/advancing assembly including a proximal tube portion and a distal tube portion pivotably connected to one another at an articulation joint, each of the proximal tube portion and the distal tube portion defining a central longitudinal axis; a proximal inner shaft rotatably disposed within the proximal tube portion, wherein the proximal inner shaft is relatively rigid, and wherein the proximal inner shaft is mechanically connected to the drive mechanism such that actuation of the trigger results in rotation of the proximal inner shaft; a distal inner shaft rotatably disposed within the distal tube portion, wherein the distal inner shaft is relatively rigid; and an intermediate drive cable mechanically interconnecting the proximal inner shaft and the distal inner shaft, wherein the intermediate drive cable is relatively flexible as compared to the proximal inner shaft and the distal inner shaft, wherein the intermediate drive cable extends from and between the proximal tube portion and the distal tube portion, across the articulation joint, wherein the intermediate drive cable defines a central longitudinal axis and wherein the central longitudinal axis of the intermediate drive cable is off-set a radial distance from the central longitudinal axis of the proximal tube portion and the distal tube portion.

The endoscopic surgical device also including at least one fastener loaded in the distal tube portion, wherein the at least one fastener is acted upon by the distal inner shaft upon an actuation of the trigger.

According to another aspect of the present disclosure, an endoscopic surgical device is provided which comprises an endoscopic anchor retaining/advancing assembly including a proximal tube portion and a distal tube portion pivotably connected to one another at an articulation joint, each of the proximal tube portion and the distal tube portion defining a central longitudinal axis; a proximal inner shaft rotatably disposed within the proximal tube portion, wherein the proximal inner shaft is relatively rigid, and wherein the proximal inner shaft is mechanically connected to a drive mechanism such that actuation of the drive mechanism results in rotation of the proximal inner shaft; a distal inner shaft rotatably disposed within the distal tube portion, wherein the distal inner shaft is relatively rigid; and an intermediate drive cable mechanically interconnecting the proximal inner shaft and the distal inner shaft, wherein the intermediate drive cable is relatively flexible as compared to the proximal inner shaft and the distal inner shaft, wherein the intermediate drive cable extends from and between the proximal tube portion and the distal tube portion, across the articulation joint, wherein the intermediate drive cable defines a central longitudinal axis and wherein the central longitudinal axis of the intermediate drive cable is off-set a radial distance from the central longitudinal axis of the proximal tube portion and the distal tube portion.

The endoscopic surgical device also comprises at least one fastener loaded in the distal tube portion, wherein the at least one fastener is acted upon by the distal inner shaft upon an actuation of the drive mechanism.

The distal tube portion may be is articulatable between a non-articulated orientation and a plurality of articulated orientations relative to the proximal tube portion.

The central longitudinal axis of the proximal tube portion and the central longitudinal axis of the distal tube portion may define a central radius of curvature for each articulated orientation of the distal tube portion relative to the proximal tube portion. The central longitudinal axis of the intermediate drive cable may define a radius of curvature that is greater than the central radius of curvature for each articulated orientation of the distal tube portion relative to the proximal tube portion.

The central longitudinal axis of the intermediate drive cable may be off-set from the central longitudinal axis of the proximal tube portion and the central longitudinal axis of the distal tube portion in a direction away from a direction of articulation of the distal tube portion relative to the proximal tube portion.

The intermediate drive cable may have an outer diameter of about 0.08″ and wherein the proximal tube portion and the distal tube portion may each have an outer diameter of about 0.22″.

A ratio of an outer diameter of the intermediate flexible drive cable to an outer diameter of either the proximal tube portion or the distal tube portion may be 2.8.

Further details and aspects of exemplary embodiments of the present invention are described in more detail below with reference to the appended figures.

BRIEF DESCRIPTION OF THE DRAWINGS

Embodiments of the present disclosure are described herein with reference to the accompanying drawings, wherein:

FIG. 1 is a perspective view of an endoscopic surgical device according to an aspect of the present disclosure;

FIG. 2 is a perspective view, with parts separated, of the endoscopic surgical device of FIG. 1;

FIG. 3 is an enlarged, perspective view, with parts separated, of an endoscopic anchor retaining/advancing assembly of the endoscopic surgical device of FIGS. 1 and 2;

FIG. 4 is an enlarged view of the indicated area of detail of FIG. 3;

FIG. 5 is a cross-sectional view of an articulation joint of the endoscopic anchor retaining/advancing assembly, as taken through 5-5 of FIG. 1, shown in an non-articulated condition;

FIG. 6 is a cross-sectional view of an articulation joint of the endoscopic anchor retaining/advancing assembly, as taken through 5-5 of FIG. 1, shown in an articulated condition;

FIG. 7 is an enlarged, cross-sectional view of a distal end of the endoscopic anchor retaining/advancing assembly, as taken along 7-7 of FIG. 1;

FIG. 8 is a perspective view of an alternate embodiment of a distal end of the endoscopic anchor retaining/advancing assembly for use in an endoscopic surgical device;

FIG. 9 is an elevational view of a distal end of a shaft assembly and an end effector secured thereto, for another endoscopic surgical device; and

FIG. 10 is a longitudinal, cross-sectional view of the distal end of the shaft assembly and the end effector for the endoscopic surgical device of FIG. 9.

DETAILED DESCRIPTION OF EMBODIMENTS

Embodiments of the presently disclosed endoscopic surgical device is described in detail with reference to the drawings, in which like reference numerals designate identical or corresponding elements in each of the several views. As used herein the term “distal” refers to that portion of the endoscopic surgical device, that is farther from the user, while the term “proximal” refers to that portion of the endoscopic surgical device that is closer to the user.

Non-limiting examples of endoscopic surgical devices which may include articulation joints according to the present disclosure include manual, mechanical and/or electromechanical surgical tack appliers, surgical clip appliers, surgical staplers, surgical stitching devices and the like.

Referring initially to FIGS. 1-7, an exemplary endoscopic surgical device, in the form of an endoscopic surgical tack applier is shown generally as 100. Tack applier 100 includes a handle assembly 110, and an endoscopic anchor retaining/advancing assembly 130 extending from handle assembly 110 and configured to store and selectively release or fire a plurality of anchors 10 therefrom.

In accordance with the present disclosure, it is contemplated that endoscopic anchor retaining/advancing assembly 130 may include a pivot or articulation joint 150 provided along a length thereof. As seen in FIGS. 1-6, endoscopic anchor retaining/advancing assembly 130 includes a proximal tube portion 130 a, a distal tube portion 130 b pivotally connected to proximal tube portion 130 a by a pivot pin 130 c at articulation joint 150.

As seen in FIGS. 1 and 2, handle assembly 110 includes a handle housing 112 pivotably supporting a trigger 114. Trigger 114 is operatively connected to a drive mechanism 116 such that each squeeze of trigger 114 results in a rotation of an inner shaft assembly 138 of proximal tube portion 130 a of anchor retaining/advancing assembly 130.

Reference may be made to U.S. Patent Publication No. 2011/0087240, filed on Oct. 20, 2010, the entire content of which is incorporated herein by reference, for a discussion and description of the operation and construction of aspects of handle assembly 110 and/or anchor retaining/advancing assembly 130 of tack applier 100, and for a discussion and description of the construction of anchors 10.

As seen in FIGS. 1-6, proximal tube portion 130 a of anchor retaining/advancing assembly 130 includes an outer proximal tube 132 secured to and extending from handle housing 112, a stiffener tube 134 concentrically and slidably disposed within outer proximal tube 132, and a relatively rigid proximal inner shaft 138 a of inner shaft assembly 138 rotatably disposed within stiffener tube 134.

Inner shaft assembly 138 includes a relatively rigid proximal inner shaft 138 a, a relatively rigid distal inner shaft 138 b, and an intermediate flexible drive cable 138 c interconnecting proximal inner shaft 138 a and distal inner shaft 138 b. Desirably, intermediate flexible drive cable 138 c is non-rotatably connected to each of proximal inner shaft 138 a and distal inner shaft 138 b, and slidably coupled to at least one of proximal inner shaft 138 a and distal inner shaft 138 b to accommodate and/or account for variations in length of intermediate flexible drive cable 138 c when intermediate flexible drive cable 138 c is in a flexed condition. It is also desirable that the drive cable 138 c is long enough that it extends proximally past the most proximal pivot of the articulation link. This reduces bending stresses on the interface between the drive cable 138 c and the proximal inner shaft 138 a.

Proximal inner shaft 138 a extends into handle housing 112 and is acted upon by drive mechanism 116. A distal end portion of distal inner shaft 138 b is slotted, defining a pair of tines 142 a and a central channel 142 b. The distal end portion of distal inner shaft 138 b is configured to retain a plurality of anchors 10 within distal tube portion 130 b of anchor retaining/advancing assembly 130.

In particular, anchors 10 are loaded into the distal end portion of distal inner shaft 138 b of anchor retaining/advancing assembly 130 such that a pair of opposing threaded sections (not shown) of each anchor 10 extend radially beyond a diameter of distal inner shaft 138 b and are slidably disposed within a helical groove of a coil 136 (FIG. 7) defined or provided in distal tube portion 130 b of anchor retaining/advancing assembly 130, and the pair of tines 142 a of the distal end portion of distal inner shaft 138 b are disposed within a pair of slotted sections (not shown) of each anchor 10.

As seen in FIGS. 3 and 7, a spiral or coil 136 is fixedly disposed within distal tube portion 130 b of anchor retaining/advancing assembly 130. Distal inner shaft 138 b extends into and is rotatable within coil 136.

As seen in FIGS. 1-3, 5 and 6, articulation joint 150 includes an articulation link 152 having a proximal end 152 a and a distal end 152 b. Proximal end 152 a of articulation link 152 is pivotally connected to a distal end of stiffener tube 134. Distal end 152 b of articulation link 150 is pivotally connected to distal tube portion 130 b of anchor retaining/advancing assembly 130, at a location offset a transverse distance from a central longitudinal axis “X” of proximal tube portion 130 a of anchor retaining/advancing assembly 130.

In accordance with the present disclosure, an articulation actuation button 118 may be slidably supported on handle housing 112. In use, it is contemplated that articulation actuation button 118 has a distal-most portion wherein distal tube portion 130 b of anchor retaining/advancing assembly 130 is oriented at about 0° relative to the central longitudinal axis “X”, and a proximal-most portion wherein distal tube portion 130 b of anchor retaining/advancing assembly 130 is oriented at about 90° relative to the central longitudinal axis “X”.

Specifically, with articulation actuation button 118 in a distal-most portion, and with distal tube portion 130 b of anchor retaining/advancing assembly 130 oriented at about 0° relative to the central longitudinal axis “X”, as articulation actuation button 118 is moved in a proximal direction, articulation actuation button 118 draws stiffener tube 134 is a proximal direction which draws articulation link 152 in a proximal direction, causing distal tube portion 130 b of anchor retaining/advancing assembly 130 to pivot about pivot pin 130 c.

Additionally, with articulation actuation button 118 in a non-distal-most portion, and with distal tube portion 130 b of anchor retaining/advancing assembly 130 oriented at a non-0° relative to the central longitudinal axis “X”, as articulation actuation button 118 is moved in a distal direction, articulation actuation button 118 pushes stiffener tube 134 is a distal direction which pushes articulation link 152 in a distal direction, causing distal tube portion 130 b of anchor retaining/advancing assembly 130 to pivot about pivot pin 130 c toward an orientation of 0° relative to the central longitudinal axis “X”.

In use, when distal tube portion 130 b of anchor retaining/advancing assembly 130 is actuated to an off-axis orientation, as will be discussed in greater detail below, distal tube portion 130 b of anchor retaining/advancing assembly 130 may be angled from between about 0° to about 90° relative to the central longitudinal axis “X”.

In accordance with the present disclosure, distal tube portion 130 b of anchor retaining/advancing assembly 130 is pivotable in a single direction relative to proximal tube portion 130 a of anchor retaining/advancing assembly 130.

In an alternate embodiment, it is contemplated that handle assembly 110 of tack applier 100 may rotatably support an articulation collar near a proximal end of anchor retaining/advancing assembly 130. It is envisioned that the articulation collar may threadably engage with a threaded end or portion of stiffener tube 134 or some other articulation rod that is pivotably connected to articulation link 152. In this manner, as the articulation collar is rotated, the threads of the articulation collar act on the threads of stiffener tube 134 and cause the stiffener tube 134 to axially translate. As stiffener tube 134 axially translates, said axial translation is transmitted to articulation link 154 to effectuate articulation of distal tube portion 130 b relative to proximal tube portion 130 a, as described above.

In accordance with the present disclosure, as seen in FIGS. 5 and 6, intermediate flexible drive cable 138 c extends from proximal tube portion 130 a to distal tube portion 130 b of anchor retaining/advancing assembly 130, across articulation joint 150. Intermediate flexible drive cable 138 c is fabricated from a torsionally stiff and flexible material, such as, for example, stainless steel. Flexible drive cable 138 c is more flexible as compared to proximal inner shaft 138 a and distal inner shaft 138 b.

Intermediate flexible drive cable 138 c defines a central longitudinal axis “X1” which is off-set a radial distance “r” from the central longitudinal axis “X” of proximal tube portion 130 a of anchor retaining/advancing assembly 130. The central longitudinal axis “X1” of intermediate flexible drive cable 138 c is off-set from the central longitudinal axis “X” of proximal tube portion 130 a of anchor retaining/advancing assembly 130 in a direction away from a direction of articulation of articulation joint 150, or in a direction away from articulation link 152.

As such, as seen in FIG. 6, when distal tube portion 130 b of anchor retaining/advancing assembly 130 is in an angled orientation, a radius of curvature “R1” of intermediate flexible drive cable 138 c is relatively greater than a radius of curvature “R2” of a comparable flexible drive cable that would be located along the central longitudinal axis “X” of proximal tube portion 130 a of anchor retaining/advancing assembly 130.

In this manner, by providing for a larger radius of curvature “R1” for intermediate flexible drive cable 138 c, it is contemplated, in accordance with the present disclosure, that an intermediate flexible drive cable 138 c having a relatively larger diameter or constructed from a relatively stiffer material can be used, as compared to any comparable flexible drive cable that would be located along the central longitudinal axis “X” of proximal tube portion 130 a of anchor retaining/advancing assembly 130.

In so doing, relatively greater torsional forces, and more accurate rotation, can be transmitted along intermediate flexible drive cable 138 c as compared to any comparable flexible drive cable that would be located along the central longitudinal axis “X” of proximal tube portion 130 a of anchor retaining/advancing assembly 130.

Intermediate flexible drive cable 138 c may have an outer diameter of about 0.08″. Proximal tube portion 130 a and distal tube portion 130 b each have an outer diameter of about 0.22″. A ratio of the outer diameter of the intermediate flexible drive cable 138 c to the outer diameter of either proximal tube portion 130 a or distal tube portion 130 b is about 2.8.

In accordance with the present disclosure, as seen in FIG. 8, it is contemplated that tack applier 100 may be configured such that distal tube portion 130 b of anchor retaining/advancing assembly 130 is configured and adapted to releasably and selectively receive a disposable loading unit (DLU) or single use loading unit (SULU), wherein the DLU or SULU includes at least an outer tube, a coil or helical thread provided along an interior of the outer tube, and an inner shaft rotatably disposed within the coil or helical thread. The inner shaft including a splined distal end portion configured to support at least one anchor 10, and a proximal end portion configured and adapted for mechanical and non-rotational connection to a distal end of an exemplary intermediate flexible drive cable 138 c.

Turning now to FIGS. 9 and 10, an articulation joint 250, in accordance with the principles of the present disclosure, may be incorporated into an endoscopic surgical device in the form of an endoscopic surgical stapler 200. Endoscopic surgical stapler 200 may be in the form of an electromechanical, hand-held, powered surgical system including an electromechanical, hand-held, powered surgical instrument that is configured for selective attachment thereto of a plurality of different end effectors (including a surgical stapler), via a shaft assembly, that are each configured for actuation and manipulation by the electromechanical, hand-held, powered surgical instrument. Reference may be made to International Application No. PCT/US2008/077249, filed Sep. 22, 2008 (Inter. Pub. No. WO 2009/039506) and U.S. patent application Ser. No. 12/622,827, filed on Nov. 20, 2009, the entire content of each of which being incorporated herein by reference, for a detailed description of the construction and operation of an exemplary electromechanical, hand-held, powered surgical instrument.

Endoscopic surgical stapler 200 includes an endoscopic shaft assembly 210 having an articulation joint 250, and a flexible drive cable 238 c, extending through articulation joint 250, to effectuate a closure and a firing of an end effector 300.

Flexible drive cable 238 c is fabricated from a torsionally stiff and flexible material, such as, for example, stainless steel. Flexible drive cable 238 c defines a central longitudinal axis “X1” off-set a radial distance “r” from a central longitudinal axis “X” of shaft assembly 210. Flexible drive cable 238 c includes a proximal end that is coupled to a distal end of rotatable drive shaft 212. Flexible drive cable 238 c includes a distal end that is coupled to a rotation nut, wherein rotation of flexible drive cable 238 c results in corresponding rotation of the rotation nut.

The central longitudinal axis “X1” of intermediate flexible drive cable 138 c is off-set from the central longitudinal axis “X” of proximal tube portion 130 a of anchor retaining/advancing assembly 130 in a direction away from a direction of articulation of articulation joint 150, or in a direction away from articulation link 152.

Articulation joint 250 includes an articulation link 240 having a proximal end 240 a and a distal end 240 b. Proximal end 240 a of articulation link 240 is pivotally connected to a distal end of an articulation bar 278. A distal end 240 b of articulation link 240 is pivotally connected to a distal neck housing 236 of an endoscopic shaft assembly 210, at a location offset a radial distance from the longitudinal axis “X” of shaft assembly 210.

Distal neck housing 236 is configured and adapted for selective connection with an end effector 300.

Shaft assembly 210 may include a reinforcing coil spring 244 surrounding flexible drive cable 238 c. Reinforcing coil spring 244 functions to help keep flexible drive cable 238 c from kinking during articulation of end effector 300. Reinforcing coil spring 244 also functions to help keep flexible drive cable 238 c from failing due to unwinding and/or “pig tailing” during rotation thereof.

In operation, as flexible drive cable 238 c is rotated, due to a rotation of first rotatable proximal drive shaft 212, said rotation is transmitted, through flexible drive cable 238 c, to the distal end of flexible drive cable 238 c and on to the rotation nut. With end effector 300 coupled to distal neck housing 236 of shaft assembly 210, and specifically, with a drive screw of end effector 300 coupled thereto via a drive axle 326, said rotation results in actuation of end effector 300.

Also in operation, upon an axial translation of articulation bar 278, for example in a proximal direction, articulation bar 278 acts on articulation link 240 to cause articulation link 240 to translate in a proximal direction. As articulation link 240 is axially translated in a proximal direction, articulation link 240 acts on distal neck housing 236 to cause distal neck housing 236 to pivot about a pivot axis of pivot pin 234. As distal neck housing 236 is pivoted, distal neck housing 236 acts on end effector 300 to articulate end effector 300 relative to the longitudinal axis “X” of shaft assembly 210.

As such, as seen in FIG. 10, when end effector 300 is in an angled orientation, a radius of curvature “R1” of flexible drive cable 238 c is relatively greater than a radius of curvature “R2” of a comparable flexible drive cable that would be located along the central longitudinal axis “X” of shaft assembly 210.

In this manner, by providing for a larger radius of curvature “R1” for flexible drive cable 238 c, it is contemplated, in accordance with the present disclosure, that a flexible drive cable 238 c having a relatively larger diameter or constructed from a relatively stiffer material can be used, as compared to any comparable flexible drive cable that would be located along the central longitudinal axis “X” of shaft assembly 210.

In so doing, relatively greater torsional forces, and more accurate rotation, can be transmitted along flexible drive cable 238 c as compared to any comparable flexible drive cable that would be located along the central longitudinal axis “X” of shaft assembly 210.

Flexible drive cable 238 c may have an outer diameter of about 0.08″.

Shaft assembly 210 has an outer diameter of about 0.22″. A ratio of the outer diameter of the flexible drive cable 238 c to the outer diameter of shaft assembly 210 about 2.8.

Reference may be made to U.S. patent application Ser. No. 13/799,379, filed on Mar. 13, 2013, entitled “Apparatus for Endoscopic Procedures”, the entire content of which is incorporated herein by reference, for a detailed discussion of the construction and operation of shaft assembly 210 and end effector 300.

Reference may be made to U.S. patent application Ser. No. 13/280,898, filed on Oct. 25, 2011, entitled “Apparatus for Endoscopic Procedures”, the entire content of which is incorporated herein by reference, for a detailed discussion of the construction and operation of end effector 300. End effector 300 may be configured and adapted to apply a plurality of linear rows of fasteners, which in embodiments may be of various sizes, and which, in certain embodiments may have various lengths or rows, e.g., about 30, 45 and 60 mm in length.

In accordance with the present disclosure, it is contemplated that handle assembly 100 may be replaced by an electromechanical control module configured and adapted to drive the flexible drive cables to fire or actuate the surgical device. The electromechanical control module may include at least one microprocessor, at least one drive motor controllable by the at least one microprocessor, and a source of power for energizing the at least one microprocessor and the at least one drive motor.

It will be understood that various modifications may be made to the embodiments disclosed herein. For example, the length of the linear row of staples or fasteners may be modified to meet the requirements of a particular surgical procedure. Thus, the length of the linear row of staples and/or fasteners within a staple cartridge assembly may be varied accordingly. Therefore, the above description should not be construed as limiting, but merely as exemplifications of preferred embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended thereto. 

What is claimed is:
 1. An endoscopic surgical device, comprising: a handle assembly including a handle housing and a trigger operatively connected to the handle housing, and a drive mechanism actuatable by the trigger; an endoscopic anchor retaining/advancing assembly extending from the handle assembly, the endoscopic anchor retaining/advancing assembly including: a proximal tube portion and a distal tube portion pivotably connected to one another at an articulation joint, each of the proximal tube portion and the distal tube portion defining a central longitudinal axis; a stiffener tube slidably disposed within the proximal tube portion; an inner shaft assembly rotatably disposed within stiffener tube, the inner shaft assembly including: a proximal inner shaft rotatably disposed within the stiffener tube, the proximal inner shaft mechanically connected to the drive mechanism such that actuation of the trigger results in rotation of the proximal inner shaft; a distal inner shaft rotatably disposed within the distal tube portion; an intermediate drive cable mechanically interconnecting the proximal inner shaft and the distal inner shaft, wherein the intermediate drive cable is relatively flexible as compared to the proximal inner shaft and the distal inner shaft, wherein the intermediate drive cable extends from and between the proximal tube portion and the distal tube portion, across the articulation joint, wherein the intermediate drive cable defines a central longitudinal axis and wherein the central longitudinal axis of the intermediate drive cable is off-set a radial distance from the central longitudinal axis of the proximal tube portion and the distal tube portion; an articulation link including a proximal end pivotally connected to a distal end of the stiffener tube and a distal end pivotally connected to the distal tube portion; and at least one fastener loaded in the distal tube portion, wherein the at least one fastener is acted upon by the distal inner shaft upon an actuation of the trigger.
 2. The endoscopic surgical device according to claim 1, wherein the distal tube portion is articulatable between a non-articulated orientation and a plurality of articulated orientations relative to the proximal tube portion.
 3. The endoscopic surgical device according to claim 2, wherein the central longitudinal axis of the proximal tube portion and the central longitudinal axis of the distal tube portion define a central radius of curvature for each articulated orientation of the distal tube portion relative to the proximal tube portion, and wherein the central longitudinal axis of the intermediate drive cable defines a radius of curvature that is greater than the central radius of curvature for each articulated orientation of the distal tube portion relative to the proximal tube portion.
 4. The endoscopic surgical device according to claim 2, wherein the central longitudinal axis of the intermediate drive cable is off-set from the central longitudinal axis of the proximal tube portion and the central longitudinal axis of the distal tube portion in a direction away from a direction of articulation of the distal tube portion relative to the proximal tube portion.
 5. The endoscopic surgical device according to claim 1, wherein the intermediate drive cable has an outer diameter of 0.08″.
 6. The endoscopic surgical device according to claim 1, wherein the intermediate drive cable has an outer diameter of 0.08″; and wherein the proximal tube portion and the distal tube portion each have an outer diameter of 0.22″.
 7. The endoscopic surgical device according to claim 1, wherein a ratio of an outer diameter of the intermediate flexible drive cable to an outer diameter of either the proximal tube portion or the distal tube portion is 2.8.
 8. An endoscopic surgical device, comprising: an endoscopic anchor retaining/advancing assembly including: a proximal tube portion and a distal tube portion pivotably connected to one another at an articulation joint, each of the proximal tube portion and the distal tube portion defining a central longitudinal axis; a stiffener tube slidably disposed within the proximal tube portion; an inner shaft assembly rotatably disposed within stiffener tube, the inner shaft assembly including: a proximal inner shaft rotatably disposed within the stiffener tube, the proximal inner shaft mechanically connected to a drive mechanism such that actuation of the drive mechanism results in rotation of the proximal inner shaft; a distal inner shaft rotatably disposed within the distal tube portion; and an intermediate drive cable mechanically interconnecting the proximal inner shaft and the distal inner shaft, wherein the intermediate drive cable is relatively flexible as compared to the proximal inner shaft and the distal inner shaft, wherein the intermediate drive cable extends from and between the proximal tube portion and the distal tube portion, across the articulation joint, wherein the intermediate drive cable defines a central longitudinal axis and wherein the central longitudinal axis of the intermediate drive cable is off-set a radial distance from the central longitudinal axis of the proximal tube portion and the distal tube portion.
 9. The endoscopic surgical device according to claim 8, wherein the distal tube portion is articulatable between a non-articulated orientation and a plurality of articulated orientations relative to the proximal tube portion.
 10. The endoscopic surgical device according to claim 9, wherein the central longitudinal axis of the proximal tube portion and the central longitudinal axis of the distal tube portion define a central radius of curvature for each articulated orientation of the distal tube portion relative to the proximal tube portion, and wherein the central longitudinal axis of the intermediate drive cable defines a radius of curvature that is greater than the central radius of curvature for each articulated orientation of the distal tube portion relative to the proximal tube portion.
 11. The endoscopic surgical device according to claim 9, wherein the central longitudinal axis of the intermediate drive cable is off-set from the central longitudinal axis of the proximal tube portion and the central longitudinal axis of the distal tube portion in a direction away from a direction of articulation of the distal tube portion relative to the proximal tube portion.
 12. The endoscopic surgical device according to claim 8, wherein the intermediate drive cable has an outer diameter of 0.08″.
 13. The endoscopic surgical device according to claim 8, wherein the intermediate drive cable has an outer diameter of 0.08″; and wherein the proximal tube portion and the distal tube portion each have an outer diameter of 0.22″.
 14. The endoscopic surgical device according to claim 8, wherein a ratio of an outer diameter of the intermediate flexible drive cable to an outer diameter of either the proximal tube portion or the distal tube portion is 2.8.
 15. The endoscopic surgical device according to claim 8, further comprising at least one fastener loaded in the distal tube portion, wherein the at least one fastener is acted upon by the distal inner shaft upon an actuation of the drive mechanism.
 16. The endoscopic surgical device according to claim 8, further comprising an articulation link including a proximal end pivotally connected to a distal end of the stiffener tube and a distal end pivotally connected to the distal tube portion.
 17. The endoscopic surgical device according to claim 8, wherein the stiffener tube is concentric with the proximal tube portion.
 18. The endoscopic surgical device according to claim 1, wherein the stiffener tube is concentric with the proximal tube portion. 